Clinic for Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, CH-8091, Zürich, Switzerland.
University Clinic for Visceral Surgery and Medicine, University Hospital Berne, CH-3010, Berne, Switzerland.
BMC Cancer. 2020 Mar 23;20(1):246. doi: 10.1186/s12885-020-6710-1.
Approximately one third of all patients with CRC present with, or subsequently develop, colorectal liver metastases (CRLM). The objective of this population-based analysis was to assess the impact of resection of liver only, lung only and liver and lung metastases on survival in patients with metastatic colorectal cancer (mCRC) and resected primary tumor.
Ten thousand three hundred twenty-five patients diagnosed with mCRC between 2010 and 2015 with resected primary were identified in the Surveillance, Epidemiology and End Results (SEER) database. Overall, (OS) and cancer-specific survival (CSS) were analyzed by Cox regression with multivariable, inverse propensity weight, near far matching and propensity score adjustment.
The majority (79.4%) of patients had only liver metastases, 7.8% only lung metastases and 12.8% metastases of lung and liver. 3-year OS was 44.5 and 27.5% for patients with and without metastasectomy (HR = 0.62, 95% CI: 0.58-0.65, P < 0.001). Metastasectomy uniformly improved CSS in patients with liver metastases (HR = 0.72, 95% CI: 0.67-0.77, P < 0.001) but not in patients with lung metastases (HR = 0.84, 95% CI: 0.62-1.12, P = 0.232) and combined liver and lung metastases (HR = 0.89, 95% CI: 0.75-1.06, P = 0.196) in multivariable analysis. Adjustment by inverse propensity weight, near far matching and propensity score and analysis of OS yielded similar results.
This is the first SEER analysis assessing the impact of metastasectomy in mCRC patients with removed primary tumor on survival. The analysis provides compelling evidence of a statistically significant and clinically relevant increase in OS and CSS for liver resection but not for metastasectomy of lung or both sites.
大约三分之一的 CRC 患者表现为或随后发展为结直肠肝转移（CRLM）。本基于人群的分析旨在评估仅切除肝脏、仅切除肺部、同时切除肝脏和肺部转移灶对原发性肿瘤可切除的转移性结直肠癌（mCRC）患者生存的影响。
在监测、流行病学和最终结果（SEER）数据库中，确定了 2010 年至 2015 年间诊断为 mCRC 且切除了原发性肿瘤的 10325 名患者。采用 Cox 回归多变量分析、逆概率加权（inverse propensity weight）、近远匹配（near far matching）和倾向评分调整来分析总生存期（OS）和癌症特异性生存期（CSS）。
大多数患者（79.4%）仅存在肝脏转移，7.8%仅存在肺部转移，12.8%同时存在肺部和肝脏转移。有和无转移切除术患者的 3 年 OS 分别为 44.5%和 27.5%（HR=0.62，95%CI：0.58-0.65，P<0.001）。转移切除术统一提高了肝脏转移患者的 CSS（HR=0.72，95%CI：0.67-0.77，P<0.001），但对肺部转移患者（HR=0.84，95%CI：0.62-1.12，P=0.232）和同时存在肝脏和肺部转移患者（HR=0.89，95%CI：0.75-1.06，P=0.196）无影响。多变量分析中通过逆概率加权、近远匹配和倾向评分调整以及 OS 分析得出了相似的结果。
这是第一项评估原发性肿瘤可切除的 mCRC 患者切除转移灶对生存影响的 SEER 分析。该分析提供了有统计学意义和临床相关的强有力证据，表明肝切除术可显著提高 OS 和 CSS，但肺或两者的转移切除术无此作用。
